Healthcare Provider Details

I. General information

NPI: 1619671021
Provider Name (Legal Business Name): KALI GUPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 HIGHWAY 192 E
LONDON KY
40741-3123
US

IV. Provider business mailing address

740 S LIMESTONE A219
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-6680
  • Fax:
Mailing address:
  • Phone: 859-257-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10924
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10924
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: